Sleep disorders affect 50 – 70 million Americans and most go undiagnosed and untreated. Untreated sleep disorders have been associated with increased risk for injuries and accidents and are linked with additional physical and mental health issues. In a first of its kind study, researchers from Brigham and Women’s Hospital (BWH) measured the impact of sleep disorders on police officer health, safety and performance. They found that sleep disorders among officers are common and are associated with poor safety and performance outcomes. The findings are published in the December 21, 2011 issue of the Journal of the American Medical Association.

“Our research shows that about 40 percent of police officers screened positive for a sleep disorder and most were undiagnosed and untreated. Untreated sleep disorders can adversely affect health and safety of law enforcement officers, and could pose a risk to the public,” said Charles A. Czeisler, PhD, MD, chief of the Division of Sleep Medicine at BWH and senior author of the study. “I am particularly impressed by the leadership that the Massachusetts State Police have demonstrated throughout this research project, and with their commitment to identify and address this important health and safety issue.”

Over a period of two years, researchers gathered data from 4,957 police officers in North America. Police officers were categorized into two groups: those who were screened onsite at police facilities, and those who volunteered to participate virtually online. The onsite survey was performed at the Philadelphia Police Department and at the Massachusetts State Police Department. The onsite survey included screenings for sleep disorders as well as surveys about health and performance. The online survey involved a sample of municipal, state, county and other law enforcement officers from across North America and was used to compare data that was collected from the two intensively sampled onsite municipal and state police departments. Follow up surveys over a period of two years were also conducted.

The most common sleep disorder was obstructive sleep apnea (OSA), a condition in which breathing is paused during sleep because the airway has become narrowed or blocked. OSA was estimated to affect 33 percent of the police officers screened. Moderate to severe insomnia affected 6.5 percent, and 28.5 percent of police officers showed excessive sleepiness.

“Sleep disorders expose individuals to increased sleepiness, which elevates the risk of motor vehicle crashes. We found that excessive sleepiness is common in police officers and that almost half report having fallen asleep while driving and about 25 percent report that it occurs at least monthly,” said Shantha Rajaratnam, PhD, co-lead author of the research paper and a sleep researcher at both BWH and at Monash University in Australia. “Positive screening for a sleep disorder increased the risk of falling asleep while driving after work, depression and burnout by more than 2-fold.”

Massachusetts State Police were at significantly lower risk for OSA than the municipal or nationwide police officers, who were nearly 60 to 80 percent more likely to screen positive for OSA than the Massachusetts State Police. The researchers hypothesize that the comprehensive on-the-job physical fitness program implemented years ago by the Massachusetts State Police may account for the lower rates of both OSA and obesity (a major risk factor for OSA) observed among this group.

Importantly, researchers reported that police officers who were identified as having a sleep disorder were more likely to have physical and mental health conditions. “Those who screened positive for OSA were 1.5 to 2 times more likely to have cardiovascular disease and diabetes,” said Laura K. Barger, PhD, co-lead author and researcher in the Division of Sleep Medicine at BWH.

During a follow-up period of up to two years, those screened with sleep disorders had a higher risk of falling asleep while driving, committing an error or safety violation attributed to fatigue, and experiencing uncontrolled anger towards a suspect. They were also more likely to report a serious administrative error and had a higher rate of absenteeism.

“Identifying the prevalence of sleep disorders in this group and developing programs that may help to address them is only the first step,” Czeisler said. “Further researcher is needed to measure the success of these programs and to determine if sleep disorder screening and treatment in occupational settings, similar to what was conducted in this study, can reduce the risks associated with these disorders.”

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